Introduction Hi-fidelity manikins are often used in simulation courses. However they are very expensive and some of the skills like drainage of pneumothorax or insertion of chest-drains/rectal probes cannot be demonstrated on these manikins as they are fully loaded with various electronic equipment inside them and puncturing will damage these expensive manikins. Hence our team developed a multi-purpose, low cost, Low-fidelity manikin where wide variety of neonatal practical skills can be practised.

Aims and methods Aim was not only to create simulation of real clinical situations but also to teach practical skills and build the concept of team working. ALS Manikin was modified as below:

1. An innovatively-designed container with red fluid was placed in abdominal cavity and connected to synthetic umbilical cord. Umbilical arterial line was connected through an innovatively-designed simulator transducer box producing arterial wave form with feasibility to vary BP using solenoid valve.

2. Manikin’s chest was drilled between ribs and lungs were made from Nitrile gloves. These lungs on connecting to flow metre were able to show positive trans-illumination test and provided air filled lungs for needle thoracocentesis and chest-drain insertion.

3. Manikin’s bottom was drilled for rectal probe insertion. Thermistor from rectal probe was removed and connexions made to an innovative resistance box. With the help of Ohms Law principle, we were able to replicate any rectal temperature with an accuracy of 0.1°C.

Following above adaptations, regular simulation sessions were initiated for:

1. Trainees to undertake practical skills like emergency needle thoracocentesis, pigtail chest drain insertion, umbilical lines insertion/sampling.

2. Train nursing staff with rectal probe insertion, familiarise with connexions of chest-drain and umbilical lines.

3. Both medical and nursing staff to work in team to develop effective communication.

Results

1. Improved team working observed between doctors and nursing staff on NICU

2. All rotating registrars have had exposure to pigtail chest-drain insertion in simulation setting and subsequently went on to undertake these skills in NICU on real patients with greater confidence.

Conclusions Our method of manikin manipulation is innovative, affordable and effective and can be implemented in any hospital setting to teach practical neonatal skills, improve team working, enhance competency at performing practical skills and work with increased confidence.